ABSTRACT
AIM: In view of the increase in the use of ethanol-containing hand sanitizers throughout the world due to the current COVID-19 pandemic, we wished to review the possible risks to patients treated with disulfiram, following a case report in which an apparent DER (disulfiram-ethanol reaction) was attributed to the cutaneous absorption of alcohol from hand sanitizers as well as by inhalation of vapour. METHOD: Simple experiments to assess the levels of absorption by each route separately. RESULTS: Our results strongly suggest that while amounts of alcohol sufficient to cause a DER may be inhaled when hand sanitizers are used in confined spaces, absorption can be avoided by dispersal of the fumes, and absorption from the skin alone does not occur in pharmacologically significant quantities. CONCLUSION: Warnings about absorption of alcohol through the skin from hand sanitizers and products such as perfumes, deodorants and after-shave (whose use is often warned against when disulfiram is prescribed) should be modified accordingly.
Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Disulfiram/adverse effects , Disulfiram/chemistry , Ethanol/chemistry , Ethanol/pharmacokinetics , Hand Sanitizers/adverse effects , Hand Sanitizers/pharmacokinetics , Pneumonia, Viral/complications , Administration, Inhalation , Breath Tests/methods , COVID-19 , Disulfiram/pharmacokinetics , Disulfiram/therapeutic use , Ethanol/administration & dosage , Ethanol/adverse effects , Hand Sanitizers/administration & dosage , Hand Sanitizers/chemistry , Humans , Pandemics , SARS-CoV-2 , Skin Absorption/drug effectsSubject(s)
Acidosis/diagnosis , Ethanol/poisoning , Hand Sanitizers/poisoning , Pruritus/drug therapy , Stupor/diagnosis , Acidosis/blood , Acidosis/chemically induced , Administration, Cutaneous , Ethanol/administration & dosage , Ethanol/pharmacokinetics , Hand Sanitizers/administration & dosage , Hand Sanitizers/chemistry , Hand Sanitizers/pharmacokinetics , Humans , Male , Middle Aged , Osmolar Concentration , Self Medication/adverse effects , Skin Absorption , Stupor/blood , Stupor/chemically inducedABSTRACT
While uncommon, ingestion of ethanol-based hand sanitizers by children may be associated with significant intoxication. We report the case of a 7-year-old with acute alcohol intoxication following hand sanitizer ingestion. Alcohol elimination in this patient followed zero-order kinetics with a clearance rate of 22.5 mg/kg/h, consistent with the limited pharmacokinetic information available for children who experience alcohol intoxication from more traditional sources.
